Why Is Pediatric Skin Health Important?
Children undergo numerous changes in their skin throughout their growth journey. Some children face difficulty due to complex skin problems, such as psoriasis (causing itchy, scaly, and inflamed patches) and atopic dermatitis (causing itchy, red, and inflamed skin). In such cases, they would require special care. We must keep a close eye on our children’s skin health and seek expert help immediately. Pediatric dermatology was first recognized as a subspecialty in 2000 to address the skin problems in children and adolescents.
One-third of hospital visits for children were due to skin problems. Recent advances in pediatric dermatology have evolved. One such important advancement is systemic therapy. It has been found useful in treating serious skin conditions, such as childhood melanoma (a rare skin cancer of melanocytes).
What Is Systemic Therapy in Pediatric Dermatology?
- Systemic therapy is different from other forms of therapy because here the drugs travel through the blood and reach the affected area to perform their action.
- Doctors advise children with severe, long-standing skin conditions such as acne, seborrheic dermatitis (causing itchy, flaky, greasy skin patches), and atopic dermatitis. They are given orally as tablets or syrups, or by injection, so they can act throughout the body.
- If standard therapies fail, doctors consider systemic therapy.
- It is prescribed for children with moderate to extreme conditions of atopic dermatitis. In a few cases, both topical and systemic therapy are used together.
- Unlike topical creams, they work from within the body.
- They reach the bloodstream and act directly on the affected areas to manage skin infections, inflammation, and immune disorders.
- It is mainly indicated for severe eczematous (causing a dry, itchy skin rash) skin conditions. For example, in atopic dermatitis, in addition to superinfections, systemic treatment is needed.
When Do Children Require Systemic Therapy?
Our skin acts as a natural barrier for disease-causing pathogens, so skin infections should be treated promptly. Skin infections can occur due to bacteria, viruses, and fungi. Based on the severity of the infection, your doctor decides on appropriate treatment plans. Systemic therapy is advised in children with severe skin infections mentioned below:
Inflammatory Conditions:
1. Infantile Atopic Dermatitis
It is a long-standing inflammatory condition that causes itching, dry skin, redness, and also sleeping problems. Most cases are dealt with topical creams and ointments. But severe, widespread cases are treated using systemic steroids that include:
- Azathioprine.
- Methotrexate.
- Mycophenolate.
- Dupilumab.
- Apremilast.
However, since long-term effects due to steroids are a concern, they are not preferred for long-term management.
2. Pediatric Psoriasis
An autoimmune, chronic condition that causes thick, inflamed, and scaly patches on your skin. Systemic drugs used here include retinoids like:
- Methotrexate.
- Cyclosporine.
- Apremilast.
- Immunotherapy.
Infections:
1. Impetigo
Impetigo is the most common skin disorder affecting children. It is caused by Staphylococcus aureus and Streptococcus pyogenes. It can be contagious and often occurs with atopic dermatitis. Systemic antibiotics in combination with topical antiseptics are administered in impetigo:
- Cephalosporins like Cephalexin.
- Amoxicillin and Clavulanic acid are highly active against Streptococcus aureus.
2. Tinea capitis
Also known as scalp ringworm, it is caused by the fungus Microsporum canis. It commonly affects children, causing patchy scalp patches. This is treated with antifungals like:
- Griseofulvin.
- Itraconazole.
- Fluconazole
- Ketoconazole.
3. Cellulitis
An acute bacterial infection caused by Streptococcus pyogenes and Staphylococcus aureus, causing swelling, erythema (redness), warmth, and pain. This is managed using:
-
High-dose oral Cephalexin is effective and safe in children with moderate cellulitis.
4. Molluscum Contagiosum
It is a common viral condition that affects children and often resolves on its own. The human-specific poxvirus causes it. It causes dome-shaped bumps. Treatments include:
- Topical Imiquimod.
- Cryotherapy in extreme cases.
5. Viral Warts
Warts are caused by the human papillomavirus and are common skin problems among children. Treatment modalities:
- Topical salicylic acid.
- Cryotherapy.
- Intralesional Bleomycin.
- Topical immunotherapy.
- Pulsed laser therapy.
- Photodynamic therapy.
6. Viral Exanthematous Condition
A widespread skin rash causing patches, red or pink spots, and bumps. They also cause headache, fever, and fatigue. Management:
- Fever and pain are managed through NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen.
- Skin rashes (more than 30 % of the body surface) are managed by systemic steroids.
7. Chickenpox
A viral infection managed by:
- Systemic antivirals such as Acyclovir are used for those who have poor immunity.
- High-dose IV oral Acyclovir or Valacyclovir for severe chickenpox in patients over 12.
8. Herpes Zoster Infections
A viral infection that is rare in children, causing burning or pain with cutaneous eruptions. Antiviral medications used include:
- Valacyclovir.
- Famciclovir.
- Acyclovir.
Autoimmune and Genetic Conditions:
1. Alopecia Areata
An autoimmune condition causing patchy hair loss.
- Managed using topical treatments.
- In extensive cases, systemic steroids and Janus kinase (JAK) inhibitors are used.
2. Childhood Melanoma
A form of skin cancer in the pigment melanocytes, causing unusual moles. Though it is rare in children, targeted therapy, cytotoxic chemotherapy, and immunotherapy are involved in the systemic treatment of melanoma:
- Immune Therapy: Immune inhibitors like Pembrolizumab, Ipilimumab, and Nivolumab.
- Targeted Therapy: BRAF inhibitors such as Vemurafenib, Dabrafenib, and Encorafenib.
Recurrent childhood melanoma is treated by targeted therapy with the help of Dabrafenib.
Birthmarks:
1. Infantile Hemangioma (IH)
These are benign tumors seen in 5% of infants, most commonly in the head and neck. Treatment is based on the affected area:
- Superficial IH: Topical Timolol 0.5 % gel.
- Deep IH: Systemic Propranolol.
2. Portwine Stains and Sturge-Weber Syndrome
Vascular birthmarks occur due to neurological problems. Treatment includes:
- Pulsed dye lasers (PDL) are considered standard.
- In resistant cases, combining PDL with topical Sirolimus can help improve prognosis.
Other Conditions:
- Acne is a common skin problem affecting 79 to 95 % of adolescents in the United States. Oral antibiotics, hormonal therapy, and drug-like Isotretinoin are used as systemic therapies.
- Erythromelalgia - Aspirin is the main drug of choice.
- Moles.
- Blood malformations.
- Pregnancy dermatoses (a group of skin disorders during pregnancy).
- Boils and abscesses.
- Insect bites.
- Scabies (a contagious skin disease causing skin itching due to mite infestation).
- Rubella or German measles (a contagious viral infection causing rashes over the face).
- Roseola (contagious Herpes virus infection causing a non-itchy, pink rash).
- Parasitic skin infections.
- Shingles (painful, blistering rash).
- Pityriasis rosea (causing an oval-shaped rash also known as the Herald patch).
Conclusion
Children develop a wide variety of skin problems. Parents should be cautious about the ill effects of poor skin health in children. Pediatric care, protective measures, and doctor-guided treatment will help us avoid the risk of skin disorders.
Systemic therapy is advised in severe skin diseases, and it becomes highly effective when combined with topical treatment. If you feel your child might have a similar dermatological problem, seek a skin care specialist for further evaluation.
Key Takeaways
- Children face many skin problems as they grow, and such conditions require prompt addressing.
- When topical treatment fails, systemic therapy is used because it acts by reaching the bloodstream and exerting its effects on affected body parts.
- Systemic therapy is cautiously used in children, and steroids are not used for long-term management.
